training partnershp & health benefits trust - 2011-2012 benefits book

2011-2012 BENEFITS BOOK 1

YOUR BENEFITS

2011-2012 GUIDE TO TRAINING AND HEALTH BENEFITS

2 MYSEIUBENEFITS.ORG

WELCOMEWelcome to the first “Your Benefits” book from the SEIU Healthcare NW Train-

ing Partnership and Health Benefits Trust. This book is designed to serve as a

complete guide to your training and health benefits. It features resources and

information to make it easier to get the support you need.

As a Home Care Aide, your training and health benefits are a critical part of

the compensation you receive. Quality training and affordable health benefits

provide the skills foundation and personal stability needed to help you deliver

excellent care to your consumers and create future career pathways.

You are the key to quality care in Washington’s long-term care system. Thank

you for all you do to promote excellence in home care.

Charissa RaynorExecutive Director, Training Partnership and Health Benefits Trust

David RolfBoard Chair, Training Partnership and Health Benefits Trust

President, SEIU Healthcare 775NW

USERNAME

PASSWORD

MANAGE TRAINING / BENEFITS ONLINE www.myseiubenefits.orgEnter your Username and Password below for easy reference

PRIMARY CARE DOCTOR NAME PHONE

URGENT CARE CENTER NAME AND ADDRESS

PRIMARY CARE DOCTOR / URGENT CARE CENTERWrite your Doctor and nearest Urgent Care Center here for reference

DAY MONTH YEAR HOURS NEEDED

TRAINING DEADLINE Write your Training Deadline here for reference


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Quick Start Guide Your Benefits Book 4 If You Need Assistance 5 Multi-language Assistance 6 Quick Start: Training and Health 7 Access www.myseiubenefits.org 8 Home Care Aide Magazine Preview 10 Course Catalog Preview 11

Training Basics Training Overview 13 How to Get the Most of Your Training 17 Interpretation 18 Online Continuing Education 19 How to Help Improve Future Classes 20

Training Standards Training Standards Overview 23 Training Standards Chart 24 Home Care Aide Categories 25 Support Contacts 26 Safety and Orientation 27

Training Policies Frequently Asked Questions 28 Classroom Policies 30 Reasonable Accommodation Policy 32

Health Benefits Health Benefits Overview 35 Participating Employers 36 Benefits Basics 37 2011-2012 Medical Plan Highlights 38 Urgent Care Centers 41 Dental and Vision Benefits 43

Wellness Your Wellness 45 Health Benefits Quick Start 51

Health Benefits Policies Frequently Asked Questions 52 Benefit Summaries 60 Group Health Options 61 Kaiser Permanente Health 68 Premera Dental 73 Willamette Dental 78 Questions and Appeals 80

Glossary 82CON

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One-Stop Resource for Training, Health Benefits

To make it easier to understand your training and

health benefits, the Training Partnership and Health

Benefits Trust put together the first “Your Benefits”

book to guide you. These benefits are

effective Aug. 1, 2011 through July 31, 2012.

Inside, you will find information about your benefits:

Training Benefits• Training standards• Classroom policies• Glossary• Student resources

Health Benefits(For eligible Individual Providers or Home Care Aides covered through their employers)

• Eligibility• Benefit summaries• Wellness guide

Where to find updatesIf there are changes to training standards or other information after the book is released, we will update “Your Benefits” book the following ways:

ONLINE - Updates will be available online at www.myseiubenefits.org/benefits

YOUR MAGAzINE- Updates will also be available three times a year in the new magazine for Home Care Aides, see Page 10 for more information.

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2012 BENEFITS BOOK 1

YOUR BENEFITS

GUIDE TO TRAINING AND HEALTH BENEFITS

QUICK REFERENCE GUIDEYOUR BENEFITS BOOK



General Training and Health Benefits SupportFor fastest response:Fill out a Contact Form at www.myseiubenefits.org/contact

Member Resource Center1-866-371-3200Mon.-Fri., 7 a.m.-7 p.m. The MRC is closed the following holidays:New Year’s DayMartin Luther King, Jr. DayPresidents’ DayMemorial Day

Independence DayLabor DayThanksgivingDay after ThanksgivingChristmas Eve DayChristmas Day

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Medical Plan SupportGroup Health Optionswww.ghc.org1-888-901-4636Mon.-Fri., 8 a.m.-5 p.m.

Kaiser Permanente1-800-813-2000www.kp.org

Dental Plan SupportPremera Blue Cross (Dental)1-800-722-1471www.premera.com

Willamette Dental1-800-359-6019www.willamettedental.com

Individual Providers: If you need information about your training or benefits eligibility, log in to www.myseiubenefits.org first. If you cannot find the answer to your question, contact help below.

Agency Providers: Contact your employer for support.

For answers to medical or dental plan questions, contact:

QUICK REFERENCE GUIDEIF YOU NEED ASSISTANCE

Specific Health Benefits Support

Specific Training SupportSee chart on Page 26 for who to contact for specific training-related questions.


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For AssistanceComuníquese con el Centro de Recursos para Miembros al 1-866-371-3200 si necesita asistencia para registrarse en su entrenameinto o para saber cuál es su elegibilidad para los beneficios de salud.

Hãy gọi Trung Tâm Nguồn Lực Thành Viên theo số 1-866-371-3200 nếu quý vị cần được trợ giúp trong việc lên lịch đào tạo hoặc tìm hiểu về điều kiện để nhận phúc lợi y tế.

훈련일정을 잡거나 건강혜택 자격 확인을 위해 도움이 필요하시면

회원지원센터 1-866-371-3200로 전화주세요.

如需在安排培训日程或了解您是否有资格获取保健福利方面获取协

助，请致电 1-866-371-3200 联系会员资源中心。

Если у Вас есть вопросы, связанные с определением расписания занятий, или относительно получения Вами пособия по нетрудоспособности, обращайтесь в Учебно-методический центр по телефону 1-866-371-3200.



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Training Quick StartIndividual Providers1. Find Your Training Standards• There are different Home Care Aide standards

depending on what category of care you provide.• Use the online Training Wizard – a tool to help

you know which category applies to you – to find your individual training standards. Go to: www.myseiubenefits.org/wizard to complete the Wizard.

2. Schedule Training Early• Locate or create your Username and Password

(see Page 8).• Go online to www.myseiubenefits.org to log in to register for training

or call the Member Resource Center at 1-866-371-3200.

3. Get Student ID Card in the Mail• Your Student ID card will be mailed to the mailing address you provided

to your primary DSHS contact. If you don’t receive your ID card within 7-14 days of your hire date, fill out a Contact form at www.myseiubene-fits.org/contact or call the Member Resource Center at 1-866-371-3200.

Agency Providers1. Review chart on Page 26 to see who can support you.

Health Benefits Quick Start1. Check your eligibility for health insurance benefits and enroll

Individual Providers: Go online to www.myseiubenefits.org to log in to see your eligibility and enroll online, or call the Member Resource Center at 1-866-371-3200. Your eligibility for health insurance depends on the number of hours you work. Agency Providers: Contact your employer to see if you are eligible for health benefits through your employer.

2. Make an appointment with your primary care doctorGo to your health insurance provider’s website or contact them by phone (see contact info on Page 5) to find available doctors and other providers. See the Health Benefits section for more details.

QUICK START

To report suspected abuse or neglect of a vulnerable adult, call toll free 1-866-END-HARM

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Manage Training and Benefits Easily OnlineThe best way to manage your training and find your eligibility for benefits is through the www.myseiubenefits.org website. We have now improved the Username and Password process to make it easier for you to access the site.

How to Log in to the Website

1. Sign up for a First Time Username and Password

2. Verify Your Information

Note: We recommend you set up an email address to receive the quickest notifications, if you do not have one, you can get a free account at Gmail.com or Hotmail.com.

First Time User

Forgot Password or Username?




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ACCESS MYSEIUBENEFITS.ORG

3. Create Your Username and Password

4. Confirm Your Username and Password

Note: You can choose any username or password you like

5. You’re Done!

Now You’re Ready to Log in to the Website!

Please write your Username

and Password on Page 2 of

this book to remember.


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Coming in Fall 2011 - Home Care Aide Magazine

As a community of Home Care Aides,

you do important work and you have

an important story to tell. You can help

raise understanding of common

challenges and experiences for

Home Care Aides to help improve the

profession.

To help share knowledge and skills

with the Home Care Aide community, a

new magazine will be published three

times a year and will focus on you and

your work. Look for the first issue in the Fall of 2011.

Magazine HighlightsTraining and Health

• Best practices for Home Care Aides

• Knowledge and skills builders

• Student participation policies and news

• Health Benefits beneficiaries policies and news

• Your safety at work

Important Updates to “Your Benefits” book• Updates to “Your Benefits” book will be printed in the magazine as well

as posted online; be sure to check your magazine for updates

MAGAZINE

SEND US YOUR STORY IDEAS!Do you have an interesting story to share of your successes or challenges as a Home Care Aide? Do you have a story about personal health and wellness? Do you have suggestions for stories or profiles you would like to see in the magazine? Send them to us! Go to www.myseiubenefits.org/stories to submit your story idea.




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Course Catalog

To help you find the Basic

Training or Continuing Educa-

tion courses you need, the

Training Partnership will

distribute a comprehensive

course catalog.

The course catalog, which

will be released in August

2011, will cover the Fall

quarter of classes and will

be an easy-to-use sup-

plment to the

online course catalog at

www.myseiubenefits.org.

Classes will be organized

by region, date and title.

The online course catalog will always have the most current information re-

garding courses. Please refer to the online catalog for updates.

COURSE CATALOG

SEIU HEALTHCARE NW TRAINING PARTNERSHIP -2011 CATALOG

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VisionOur vision is that every long-term care worker is a professional who has been trained rigorously, whose work is well respected and well compensated, who has meaningful opportunities for professional development and career growth, and who provides high quality care.

‘‘ The classes were very helpful and they gave me new, healthier ways to

deal with challenges at work.

– Jasmine, Training Partnership Student

QUALITY TRAINING, QUALITY CAREThe Training Partnership under-

stands that adult learners bring a

broad set of life experiences, educa-

tion levels, and English language

proficiency to the classroom. To

meet that diversity, learning experi-

ences are designed for you, adult

students who bring previous knowl-

edge and a passion for their work to

class. The focus is on practical skill

development that will help you to do your job.

What can you expect from Basic Training courses?• As a student, you can expect to meet an instructor with direct care

experience who is passionate about supporting Home Care Aides in their

professional growth.

• You can expect to meet and work with other students in small group

exercises, activities, role plays and games.

• You can expect opportunities to learn using different methods like watch-

ing video clips, completing written activities, and presenting to others.

• You can expect to learn specific skills, see them demonstrated and then

have a chance to demonstrate the skill yourself.


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What characterizes the work of the Training Partnership?There are several themes that infuse the courses, actions, and work of the Training Partnership. They are:

• Dignity of the work and the Home Care Aides who do the work;

• Dignity of the consumer whose preferences, individuality, and needs must be respected;

• Empowerment of the Home Care Aide to improve their lives and the lives of consumers;

• Professionalism of the workforce; and

• Cultural competency and inclusiveness to honor differences.

• You can expect to use a

student guide during class

which you can keep as a future

resource.

• You can expect to be asked

what you think, to share what

you know, to contribute to discussion, and to answer questions.

What can you expect from Continuing Education courses?• You can expect options in course formats, including in-person and online

learning choices.

• You can expect choice in the style courses are taught, from expert lec-

tures to group discussions.

• You can expect variety in subjects, from broad overviews to in-depth

explorations on specific topics.

• You can expect instructors who are not only professional, but have

knowledge or expertise in the area they are teaching.

MissionOur mission is to train and develop professional long-term care workers to deliver high quality care.


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HOW TO GET THE MOST OF YOUR TRAININGUse the Training WizardStart with the easy online Training Wizard to find the training you need.

Go to: www.myseiubenefits.org/wizard to complete the Wizard.

Register Early for TrainingIf you need Basic Training, we encourage you to register for your classes

within the first 30 days of hire to get the best choice of class options. If you

need Continuing Education (CE) classes, register as early as possible to get

the best choice of class options before your deadline.

Take Online Learning for Continuing Education CreditsOnline Continuing Education courses are an easy and convenient way to get

the CE hours you need as a Home Care Aide. You can view available courses,

take classes and view your credits all from your computer – 24/7.

Go Online for Fastest Service and SupportThe www.myseiubenefits.org web portal is your comprehensive resource for

available classes, your current training status, benefits eligibility and much

more. Log in to the portal first to get the answers you need. Instructions to get-

ting a username and password are on Page 8.

Update Your Contact InfoEnsure you are receiving the most current information about your training by

updating your contact information with your employer. If are you an Individual

Provider, update your information with your primary DSHS contact. If you are

an Agency Provider, update your information with your employer.

‘‘ The class on mental health really helped me understand the issue better

and gave me tools. I feel more prepared to help my client with mental

health issues now.

– Marcos, Training Partnership Student


INTERPRETATIONIndividual Providers: The Community Interpretation option is available to you.

Agency Providers: Indicate to the person who registers you for class that you will be bringing

an interpreter.

Community InterpretationThe Training Partnership values the diversity of Home Care Aides. Basic Training

courses are offered in English, Cantonese, Spanish, Russian, Korean, and Vietnam-

ese. For those students who speak another primary language and are unable to take

courses in English, we offer a Community Interpretation option.

Steps to Register for Community Interpretation

1. Notify the Training Partnership: At the time of course registration, tell us if you will

be bringing someone with you to serve as your interpreter.

2. Reserve Space: If you are bringing someone to interpret, you are responsible for

telling them when and where the class will be held and for reserving space for them

in the class.

3. Orientation: If you have a friend or family member interpret for you, we offer a tip

sheet and other information that will help prepare your interpreter to assist you in

class.

Additional information about the Community Interpretation Orientation can be found

at www.myseiubenefits.org/training/interpretation


ONLINE CONTINUING EDUCATIONAs of August 2011,

there are 10 Continuing

Education (CE)

classes you can take

online by going to


More classes will be

added throughout

the year.

With online classes you

pick the time and topics

that work for you. You can see the available

courses, register and access courses, receive

credit, and navigate help information – all

online and all 24 hours a day!

Each online course takes about one hour

to complete, which may vary depending on

learning style, material covered and Internet

connection speed.

Best Practices for the Professional Home Care Aide

Traumatic Brain Injury

Body Mechanics

Infection Control: Promoting Health and Well-Being

Better Health through Nutritious Cooking

An Introduction to Mental Illness

Multiple Sclerosis

An Introduction to Developmental Disabilities

An Introduction to Physical Disabilities

An Introduction to Dementia

Online Continuing Education Classes as of August 2011

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‘‘ I loved being able to

take the Multiple

Sclerosis module

online. I learned a

lot and I could do it

at home!

– Abdul, Training

Partnership Student


HELP IMPROVE FUTURE CLASSESParticipate in strengthening future classes – a call to action

Individual Providers: Use course reviews and

the Wiki below.

Agency Providers: Use course reviews to provide feedback.

Course ReviewsAll Home Care Aides are encouraged to

complete a course review online at

www.myseiubenefits.org after each course

you take. Course reviews are allow the Training Partnership to make adjustments

in course content and instructors. Your feedback is taken seriously.

How do you submit a course review? Course reviews are available on your

student profile. Log in with your username and password, select manage my

training, and under the completed training box, click “review now.”

WikiThe Training Partnership welcomes the participation of home care aides, con-

sumers, instructors and employers in the process of curriculum development.

You’re invited to give your feedback on existing courses created by the Training

Partnership as well as give suggestions for future courses by using the wiki.

The wiki is a website which allows you to give your input. You can comment

on current classes, suggest additional topics and subjects, and even provide

comments on classes that in the development stages.

How do you access the wiki? Visit http://trainingpartnership.pbworks.com

• If you have logged in previously, your username is your email address.

• If you’ve never visited the wiki before, you can request access and in the next two business days, you’ll receive a response email with a link to activate your account.

Use the comment box at the bottom of any page to enter your suggestions on

how to make training even better.

Course ReviewsHow do you submit a course review? Course reviews are available on your student profile. Log in with your username and password, select “manage my training,” and under the completed training box, click “review now.”


Volunteer Auditor ProgramHave you ever wished you could register for a class that is not required for

you to take? The Training Partnership is excited to announce a new program

designed to help increase the feedback from our students about courses while

giving you access to more classes. The Volunteer Auditor Program is designed

for students who want to volunteer to sit in on classes around the state. In

exchange for feedback on curriculum, instructors and classroom spaces,

students can take additional classes which either are not required for them, or

exceed their training needs.

If you are interested in becoming a Volunteer Auditor, the Training Partnership

will orient you to our expectations for observing courses and what to look for.

Once you have been oriented, you can register for courses and participate like

a typical student. After the class you go online to complete a survey and share

your experience with the Training Partnership. Courses will appear in your

training record as audited. Auditing can only happen once you have met your

training standards for that year.

If you are interested in becoming a student auditor, contact the Training

Partnership at our Contact form www.myseiubenefits.org/contact. We antici-

pate this program will start in the fall of 2011.

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TRAINING STANDARDSThe recent budget passed by the state legislature resulted in funding cuts that

impact the Training Partnership. The legislation suspended the higher training

standards of Initiative 1029, which set training levels for Home Care Aides.

See a complete list of training standards on the following page.

Basic Training CurriculumAs of July 1, 2011, Initiative 1029 –

which increased basic training stan-

dards to a maximum of 75 hours

– was suspended. The result was

going back to previous standards

which capped basic training hours

at 28 and up to six hours of Safety

and Orientation. In response, the

Training Partnership has revised its

basic training curriculum to address

the new hours requirement. This

revised curriculum, approved on

July 14, 2011 as an ADSA alternate

basic training curriculum, is called Accelerated Basic Training.

Continuing EducationThe Continuing Education requirement remains 10 hours per year. The Train-

ing Partnership provides quality Continuing Education (CE) classes that help

Home Care Aides (HCA) maintain skills in the profession and provide knowl-

edge to reach the highest standards of practice.

CE classes are widely available at 150 sites across the state and 10 classes are

available online all day, every day. The classes cover a broad range of subjects.

You choose the ones that are most suited to your interests and the consumers

you serve.

Initiative 1163Initiative 1163 will appear on the ballot in November. If the initiative passes it will reinstate the higher-quality training and certification standards for most new Home Care Aides (exempt-ing those caring for a parent or child) on Dec. 8, 2011. Home Care Aides who have already taken Basic Training will not need to take the higher quality training. For more on I-1163, visit www.yes1163.com.org

www.yes1163.com


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Home Care Aide (HCA) Provide care to a consumer living in his or her home.

Agency Provider (AP)Provide care to a consumer living in his or her home. Employed by a private homecare agency.

Individual Provider (IP)Provide care to a consumer living in his or her home. Employer of record is DSHS.

Credentialed Agency Provider

This is an AP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Credentialed Individual Provider

This is an IP with a current healthcare credential as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Nursing Assistant Certified (NAC), Physical Therapist, Occupational Therapist or Medicare-Certified Home Health Aide.

Parent Individual Provider (HCS/AAA)

This is an IP who provides care to his/her own adult child and contracted through Home and Community Services (HCS) and/or an Area Agency on Aging (AAA).

Parent DD Individual Provider (DDD)

This is an IP who provides care to his/her own adult child with a developmental disability and is contracted through the Department of Developmental Disabilities (DDD).

Childcare Individual Provider (DDD)

This is an IP who provides care to a consumer under the age of 18 and is contracted through the Department of Developmental Disabilities (DDD).

Respite Workers (DDD)This is an IP who provides short, intermittent relief for person normally providing care to waiver individuals.

HOME CARE AIDE CATEGORIES

TRAIN

ING

STAN

DA

RDS

The Training Partnership provides training to a variety of Home Care Aides. The chart below describes the different categories of HCAs


WHO TO CONTACT FOR TRAINING SUPPORT

INDIvIDUAL PROvIDERS

AGENCy PROvIDERS(visiting Nurse

Homecare, Senior Life Resources,

Oly CAP, CoastalCAP,

Full Life)

AGENCy PROvIDERS

(Addus, Chesterfield, KWA, ResCare, SeaMar,

Amicable)

AGENCy PROvIDERS

(Catholic Community

Services, CDM)

Class registration and rescheduling Website or MRC Website or MRC Your Employer Your Employer

How to complete your training Website or MRC Website or MRC Your Employer Your Employer

Username and Password assistance Website or MRC Website or MRC Website, MRC

or Employer Your Employer

Confirmation Code Website or MRC Website or MRC MRC Your Employer

Requesting a student ID Website or MRC Website or MRC MRC Your Employer

Requesting a certificate Website or MRC Website or MRC MRC Your Employer

Confirming class schedule Website or MRC Website or MRC Website, MRC

or Employer Your Employer

Training requirement and deadlines Primary DSHS Contact Your Employer Your Employer Your Employer

Questions about payment Primary DSHS Contact Your Employer Your Employer Your Employer

Change of address Primary DSHS Contact Your Employer Your Employer Your Employer

Change in training standards due to change in employment status

Primary DSHS Contact Your Employer Your Employer Your Employer


If you are in a category that requires either Safety or Orientation training (or

both) you should have received a kit at the time of hiring or contracting.

The kit contains the following:

1. Instructions on “How to Complete and Receive Credit for

Safety and/or Orientation.”

2. Three DVDs: Orientation, Safety Training Part 1, Safety Training Part 2.

3. An activity sheet titled, “Safety and Orientation Self-Study Extension.”

4. Supplemental information titled, “Orientation & Safety – A Reference

Tool for Individual Providers.”

Your deadline for completing Safety

and/or Orientation is

14 days from your date of hire.

If you did not receive the Safety and

Orientation Kit, notify your DSHS

contact immediately

or contact the

Training Partnership at

www.myseiubenefits.org/contact

SAFETY AND ORIENTATION For Individual Providers

TRAIN

ING

STAN

DA

RDS

SAFETY &ORIENTATION

SEIU HEALTHCARE NW TRAINING PARTNERSHIP

The Training Partnership trains and develops professional long-term

care workers to deliver high quality care and support to older adults

and people with disabilities.

S E I U H E A L T H C A R E N WT R A I N I N G PA RT N E R S H I P

WWW.MYSEIUBENEFITS.ORG 635 ANDOVER PARK WEST SUITE 200, TUKWILA, WA 98188

NEED HELP? CONTACT THE MEMBER RESOURCE CENTER1-866-371-3200


1. What is www.myseiubenefits.org?

The website www.myseiubenefits.org is where you can read important announcements from the Training Partnership, learn about our different programs and ask questions. On the website, you can register for classes, see your training his-tory and track your progress. You can also take online Continuing Education classes by going to this website.

2. How do I get my training certificate?

Your Basic Training certificate should be mailed to you within two weeks from the day you complete all hours of your required basic training.

You should receive your Continuing Education certificate within one month following the day you complete all hours of your required continu-ing education credits.

Refer to the Support chart on Page 26 if you need assistance.

3. How do I get a Student ID?

Your Student ID card will be mailed to the mailing address you provided to your employer (DSHS or Agency) within 7-14 days of your hire date. If you do not receive your ID card, please check with your employer to make sure your address is correct. Replacement cards can take up to four weeks to receive. For fastest class check in, bring your Student ID. Bring a driver’s license, passport, or other legal identification to class.

Refer to the Support chart on Page 26 if you need assistance.

4. How do I change my address with the Training Partnership?

Ensure you are receiving the most current information about your train-ing by updating your contact information with your employer. If are you an Individual Provider, update your information with your primary DSHS contact. If you are an Agency Provider, update your information with your employer.

I have a question about wages for training? Contact your employer or your DSHS case manager. The Training Partnership cannot answer questions regarding wages.

FREQUENTLY ASKED QUESTIONS


5. How do I log in to www.myseiubenefits.org?

There is now a new and improved easier process for logging in to the website. Follow the instructions on Page 8 to log in.

6. I have a question about wages for training.

Contact your employer or your DSHS contact. The Training Partnership cannot answer questions regarding wages

7. I arrived to class and I am not on the roster, what do I do?

Only registered students and interpreters can attend Training Partner-ship classes. If you are not on the roster, you will need to reschedule your class.

8. How do I provide feedback about a class?

Your feedback is very important to us and we want to know about your class experience with the Training Partnership. You can complete a course review after attending a class by going to www.myseiubenefits.org. For more information on submitting feedback, see Page 20.

POLICIES



At the Training Partner-

ship we know you have

taken your valuable time

to come to class. To sup-

port each other and en-

sure everyone can get the

most out of each class,

we have created the

following polices in order

to create a successful

learning environment.

Class Registration• Students need to be registered for class and on the class roster in

order to take a class.

• If you have not previously registered for a class, you will not be able to take the class.

• If you are not on the class roster, you will not get credit for the class.

Only Registered Students and Interpreters are Allowed in Class• The only people allowed in class are registered students and

registered interpreters.

• Students may not bring consumers, children, or any other visitors to class.

Classes Start On Time• If you arrive to class after the start time, you will be considered late,

you will need to reschedule your class.

• You should arrive to class 15 minutes before the start time to

avoid being late.

Bring Picture ID• Students are expected to show valid picture ID to sign in for class.

• You should bring your Training Partnership ID if you have one.

CLASSROOM POLICIES


Student Participation• Students are expected to fully participate in the learning experience.

• Personal phone calls or other personal matters should be taken care of during breaks.

Class Cancellation• A student will need to cancel class registration at least 72 hours in

advance of the class time.

• If the Training Partnership has to cancel a class, a notification of the class cancellation will be sent to you based on the communication preference in your online profile. The Training Partnership will work with you to reschedule the class.

No Shows• Cancelling late or not attending class results in a no show. After two

no shows, you will have to pay a $25 no-show fee to access training.

Appeals Process• If you wish to appeal the $25 “no show” fee because you believe

you had a good reason for not attending the class you must file an appeal.

• The appeal must be filed on an appeal form that is available at www.myseiubenefits.org.

Inclement Weather• If the Training Partnership has to cancel a class due to inclement

weather, a notification of the class cancellation will be sent based on the communication preference in your profile. The Training Partner-ship will work with you to reschedule the class.

POLICIES

CLASSROOM POLICIES


Policy on Reasonable Accommodation of Students with DisabilitiesThe SEIU Healthcare NW Training

Partnership (“Training Partnership”)

admits students regardless of race,

color, national origin, ethnic origin,

gender, age, disability and sexual ori-

entation to all the rights, privileges,

programs, and activities gener-

ally accorded or made available to

students by the Training Partnership.

It does not discriminate on the basis

of race, color, national origin, ethnic

origin, gender, age, disability and

sexual orientation in administration

of its training and educational poli-

cies, admissions policies, scholar-

ship and loan programs, and other

Training Partnership administered

programs.

Students with disabilities have the

right to request and receive reason-

able accommodation so that students may have the opportunity to take full

advantage of the Training Partnership’s programs and activities.

When is a person regarded as having a disability?For purposes of accommodation, a person is regarded as having a disability if

he or she has a sensory, mental, or physical impairment that is medically cog-

nizable or diagnosable or exists as a record or history or is perceived to exist.

What is Reasonable Accommodation?Reasonable accommodation means modifying or adjusting practices, proce-

dures, policies, educational services and delivery, or the training environment

so that a student with a disability can enjoy equal educational opportunity, so

long as (1) there is sufficient medical evidence establishing a relationship be-

tween the disability and the need addressed by the specific accommodation;

and (2) it does not impose an undue hardship on the Training Partnership.

REASONABLE ACCOMMODATION POLICY

What is Reasonable Accommodation?Reasonable accommodation means modifying or adjust-ing practices, procedures, policies, educational services and delivery, or the training environment so that a student with a disability can enjoy equal educational opportu-nity, so long as (1) there is sufficient medical evidence establishing a relationship between the disability and the need addressed by the specific accommodation; and (2) it does not impose an un-due hardship on the Training Partnership.


What is Undue hardship?Undue hardship means, among other things, an excessively costly, extensive,

substantial or disruptive modification or one that would fundamentally alter the

nature or operations of the Training Partnership or its programs.

Overview of Accommodation ProcessTo request reasonable accommodation, a student with a disability should re-

quest accommodation from the Training Partnership by completing the “ADA

Request Form” found at www.myseiubenefits.org or by calling the Member

Resource Center. Once the request is received by the Training Partnership,

the Accommodation process will start, during which the student will be asked

to provide current documentation of his or her disability, the functional limita-

tions resulting from the disability and recommendations for specific accom-

modations.

As part of the Accommodation process, the Training Partnership will confer

with the student to identify appropriate and reasonable accommodations that

may be warranted under the particular circumstances.

The Training Partnership has the right to establish qualifications and other

essential standards and requirements for its courses, programs, activities and

services. All students are expected to meet these essential qualifications, stan-

dards, and requirements with or without reasonable accommodations.

More detailed information on the Accommodation process can be found at


REASONABLE ACCOMMODATION POLICYPO

LICIES

34 MYSEIUBENEFITS.ORGHEAL

TH B

ENEF

ITS


AFFORDABLE HEALTH BENEFITS FOR YOUFor eligible Individual Providers and Agency Providers, the

Health Benefits Trust is a nonprofit organization providing affordable health

coverage focused on keeping you healthy. The health benefits offered by the

Health Benefits Trust are part of a community of care that starts with the well-

ness of you, the Home Care Aide.

2011-2012 Benefits PlanThe Health Benefits Trust negotiated the 2011-2012 benefits – that took effect

on Aug. 1, 2011 – to fulfill the following goals:

• Low out-of-pocket costs for Home Care Aides

• Emphasis on preventive care to encourage wellness

• Increased participation in health risk assessments

• Higher use of urgent care facilities in urgent situations that don’t

require emergency-room care

• Encouraging lower-cost prescriptions through mail order services

• Encouraging use of in-network providers

The 2011-2012 benefits plan accomplishes those goals and allows for the continuation of affordable, quality benefits for all eligible Home Care Aides.

How to EnrollIndividual Providers: You can enroll by logging in to

www.myseiubenefits.org and by filling out the enrollment form.

Agency Providers: Contact your employer for enrollment information.

Call the Member Resource Center toll-free at 1-866-371-3200

to get answers to your questions about eligibility for benefits.

HEALTH BENEFITS BASICS


HEALTH PLAN PARTNERSWe partner with the following health insurance providers to provide benefits for eligible Home Care Aides.

Group Health Options Offering you a health plan that gives you access to coordinated care and coverage that makes staying healthy easy.

Kaiser Permanente A large national health insurer, Kaiser provides coordinated care and innovative health care programs.

Premera Blue Cross (Dental)Premera offers dental insurance to Health Benefits Trust beneficiaries.

Willamette Dental Group Willamette is a managed dental program that provides general and specialized dental services to patients all over Washington and Oregon.

PARTICIPATING EMPLOYERSWashington employers whose employees are eligible for benefits through the Health Ben-

efits Trust. NOTE: This list may change, check with your employer to verify participation.

AAA Residential ServicesAddus HealthcareAmicable HealthcareCatholic Community ServicesCDMChesterfield HealthcareFull LifeHome Care Services of MontanaKWALower Columbia Community Action Council

Oly CAPCoastal CAPSenior Life Resources NorthwestState of Washington (employer of record)Visiting Nurse Home Care

NOTE: ResCare is in the final stages of preparation to join the Health Benefits Trust.


BENEFITS BASICSHome Care Aides get the following comprehensive benefits through

the Health Benefits Trust:

MedicalNobody ever plans to get sick, but the Health Benefits Trust has you covered.

Depending on where you live, your medical, vision and prescription drug

coverage will be provided by Group Health Options or Kaiser Permanente. You

pay very little out-of-pocket for the following services:

• Doctor office visits

• In-patient hospitalization

• X-rays and diagnostic imaging

• Laboratory services

• Mental health

• Hearing exams

• Chiropractor visits

• Acupuncture

• Mammograms

• Allergy shots and other injections

• Routine immunizations

• Rehabilitative therapies

• Maternity services

Vision• Routine exams

• Hardware, such as glasses and contacts Prescription Drugs• Generic drugs

• Brand-name drugs DentalThe Health Benefits Trust helps with routine dental care as well as dental

emergencies. Dental benefits are provided by Premera Blue Cross Dental and

Willamette Dental.

Preventive care: There is no annual

deductible for preventive proce-

dures. Covered procedures include

check-ups, cleanings and X-rays.

Basic procedures: Covered proce-

dures include fillings, oral surgery,

periodontics (gum disease) and

endodontics (root canals).

Major procedures: Covered procedures

include crowns, dentures and bridges.

HOW MUCH DOES IT COST? The Health Benefits Trust works hard to minimize the amount you pay out-of-pocket for your healthcare. You pay $25 per month toward the premium for medical/prescription/vision and dental coverage. You cannot enroll for only medical or only dental coverage.



2011-2012 Medical Plan Highlights Thanks to effective organizing by Home Care Aides and strong negotiating by the Health Benefits Trust, the health benefits Home Care Aides will receive through July 31, 2012, remain largely unchanged. Although insurance premiums are increas-ing overall, the Home Care Aide cost share will remain the same at $25 per month.

The level of insurance coverage provided remains the same, with a few exceptions that encourage good use of Health Benefits Trust resources:

EMERGENCY ROOM

Whenever you use the Emergency Room, you will pay a $200 copay regard-less of facility. However, if you are admitted to the hospital as a result of your visit to the ER, the $200 will not be charged.

As a better alternative to the Emergency Room in most situations, Urgent Care is available and your copay will be just $10 for Group Health and $30 for Kaiser.

IN-NETWORK PROVIDERS

You do not have to pay as much when accessing an in-network group of providers and facilities, including purchasing your prescription drugs.

• In-network services continue to have a $0 annual deductible and $10 office visit copay. However, preventive care now is paid in full with no copay.

• If you choose to access care out-of-network, your annual deductible will increase from $200 to $500.

Premium Cost Share Unchanged The premium cost share for Home Care Aides will remain the same at $25 per month.

Understanding Health Insurance TermsCopayThe amount you will pay at the time of your visit.

DeductibleThe amount that you pay for covered services before the plan begins paying in a given year. You need only to satisfy your deduct-ible once in a calendar year.

In-networkYou don’t have to pay as much when you use this network of providers.

Out-of-networkA broader network of providers where you may access care but your out of pocket expenses will be higher than with in-network providers.


BENEFIT IN-NETWORK OUT-OF-NETWORK NOTES

Preventive Care Covered In Full

Covered in full up to $300

Mammograms Covered In Full

$500 deduct, 80% Covered

Routine mammograms

Urgent Care

Group Health Options $10$10 copay, deductible and coinsurance apply

Kaiser $30 No out-of-network allowed

Prescription Drugs Generic $15 copay $20 copay30 day supply; For Kaiser, no out-of-network allowed

Brand $30 copay $35 copay30 day supply: For Kaiser, no out-of-network allowed

Group Health Options Mail-order $30 Generic $75 Brand Not applicable 90-day supply

Kaiser Mail-order $30 Generic $60 Brand Not applicable 90-day supply

Emergency Room $200 copay $200 copay Waived if admitted

Out-of-Network Deductible

Group Health Options $0 $500

Kaiser $0 Not allowed No out-of-network allowed

2011-2012 PLAN HIGHLIGHTS AT A GLANCE

PRESCRIPTION DRUGS

The prescription drug copays are increasing slightly. However, by using mail-order service to receive your prescriptions, you will now receive a discount on your prescription copay.

HEALTHCARE REFORM CHANGES

As a result of Healthcare Reform, your coverage will be improved in the following ways:

• There is no longer a lifetime maximum cap of benefits.

• There are no longer lifetime benefit limits for essential benefits.

Health Profile = $25 for youFill out your Health Profile, offered by Group Health Options or the Total Health Assessment, offered by Kaiser Permanente and the Health Benefits Trust will send you a check for $25! Good for your health, good for your wallet.



Bellevue Medical CenterMonday-Friday8 a.m.-5 p.m.11511 N.E. 10th St.Bellevue, WA 98004425-502-3000

Everett Medical CenterMonday-Friday8 a.m.-5 p.m.2930 Maple St.Everett, WA 98201425-261-1500

Olympia Medical CenterMonday-Friday8 a.m.-5 p.m.700 Lilly Road N.E.Olympia, WA 98506360-923-7000

Capitol Hill CampusMonday-Friday8 a.m.-5 p.m.201 16th Ave. E.Seattle, WA 98112206-326-3000

Silverdale Medical CenterMonday-Friday8 a.m.-5 p.m.10452 Silverdale Way N.W.Silverdale, WA 98383360-307-7300

Riverfront Medical CenterMonday-Friday8 a.m.-5 p.m.322 W. North River DriveSpokane, WA 99201509-324-6464

Tacoma Medical CenterMonday-Friday8 a.m.-5 p.m.209 Martin Luther King Jr. WayTacoma, WA 98405253-596-3300

Group Health Options: Urgent Care CentersSeven Group Health medical centers have Urgent Care Centers, most with evening, weekend, and holiday hours. Urgent Care Centers at the Bellevue Medical Center and Capitol Hill Campus in Seattle are open 24 hours a day, seven days a week.

Use the Group Health Options Provider Directory www.ghc.org to find urgent care providers in other areas. (Select “All Special-ists,” then select “Urgent Care” from the drop-down list.)

URGENT CARE SAVES YOU MONEYThe out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $10 for a trip to Urgent Care with Group Health Options, and $30 with Kaiser.



Dental BenefitsHealthy teeth and gums are a critical part of

your overall health. That’s why comprehensive

dental benefits are included in the coverage

you receive through the Health Benefits Trust.

To keep your teeth healthy, your dental

benefits include at no additional cost to you

for in-network services:

• Routine exams

• Regular cleanings

• X-rays

• Gum care

• Fillings

Depending on your plan, a portion of the cost of the following procedures may

also be covered:

• Crowns, inlays

• Dentures

• Implants

To take the best care of your teeth and gums, you should see your dentist

every six months for a complete exam and cleaning.

Vision BenefitsKeeping your eyes healthy and keeping optical prescriptions updated are also

important to your overall health and well being. Vision benefits through the

Health Benefits Trust are an affordable way to ensure your sight is protected.

•For a $10 copay per visit, you receive routine

vision care.

•Every two years you receive $200 worth of optical

supplies, including contact lenses and frames.

Did You Know? The American Dental Association says healthy gums are linked to a healthy heart? Another reason to visit your dentist regularly.


Did You Know? As part of a complete wellness plan, everyone should have regular eye exams, whether or not you’re having any noticeable signs of problems.

44 MYSEIUBENEFITS.ORGWEL

LNES

S


WELLN

ESS

YOUR WELLNESS Working Together To Keep You Healthy

As a Home Care Aide, you know how important it is to stay healthy. Through

the benefits you receive through the Health Benefits Trust, you receive excel-

lent health, dental and vision benefits at a low cost.

To ensure that health care for Home Care Aides continues for years to come,

there are three things we all need to do:

• Keep ourselves healthy

• Keep out-of-pocket costs low

• Help control health care costs so we do not have to pay more next year

Four Steps to Better HealthThere are four key ways you can maximize your benefits for better health:

• Making your first primary care appointment

• Using urgent care vs. the emergency room

• Managing prescriptions

• Completing a Health Profile or Assessment

Follow the steps below and on the following pages to get started.

URGENT CARE

URGENT CARE

URGENT CARE URGENT CARE

HEALTHYHOME CARE AIDE

See a Primary Care DoctorFind a doctor, set up your first visit

Health Profile or AssessmentFill out an easy online quiz

Find Urgent Care CentersLocate the centers near you

Manage Your PrescriptionsTransfer to Kaiser or Group Health Options


See a Primary Care Doctor1One of the most important things to do is to select a primary

care doctor and set up a first visit. A strong relationship with

your primary care doctor (also known as your primary care

provider) is at the heart of your care.

How to Select Your Primary Care Doctor

Go Online: Use the provider directory at www.ghc.org or www.kp.org to find a

personal physician who’s a good match for you. or

Call: Group Health Options Customer Service at 1-888-901-4636

Kaiser Permanente Customer Service at 1-800-813-2000

Make an Initial Primary Care Appointment = Earn $10!

Establishing a relationship with your primary care provider is important to your

health. If you obtain a preventive care/wellness visit from your primary care

doctor within the first three months of your

coverage effective date, the Health Benefits

Trust will pay you $10. You may only

receive the benefit once.

URGENT CARE

DID YOU KNOW?Your out-of-pocket expenses are much less when you use in-network providers. Assuming you have four office visits this year, your out-of-pocket expenses using a Group Health provider would be $40 vs. $500 or more with an out-of-network provider.


Complete a Health Profile or Assessment

How Healthy are You?

The Health Profile and Total Health Assessment

will help you find out!

• What are your daily eating habits?

• How often do you exercise?

• How often do you drink alcohol?

Find out how the answers to questions like these affect your health.

Your Health Profile or Total Health Assessment are online quizzes to help you

and your doctor take better control of your health. Filling out a Health Profile is

a key step on the path to better health.

Fill out a Health Profile or Assessment, Receive $25!

Beginning Aug. 1, 2011, Home Care Aides who complete a Group Health Options

Health Profile or Kaiser Permanente Total Health Assessment will receive a $25

check from the Health Benefits Trust. You will receive a check within 6–8 weeks of

submitting your profile.

2

URGENT CARE

Register for MyGroupHealth for Members at ghc.orgTo access the Health Profile, you need to upgrade your MyGroupHealth account so you have access to online services. To register, visit www.ghc.org or call Website Customer Service at 1-888-874-1620.

Register for Kaiser Online AccessUsing Kaiser online access, you can fill out your Total Health Assessment. Register at www.kp.org

WELLN

ESS


Locate Closest Urgent Care Center

It is important to locate your Urgent Care Center in

advance because in the event you need urgent care, it is

often a difficult time to look for an Urgent Care Center.

3URGENT CARE

DID YOU KNOW?Urgent Care is a much more affordable option for Home Care Aides through the Health Benefits Trust. The out-of-pocket cost for a trip to the emergency room is $200 (waived if you are admitted to the hospital) vs. just $10 for a trip to Urgent Care with Group Health Options and $30 with Kaiser.

Where to Find Urgent CareGROUP HEALTH OPTIONS: Seven Group Health

medical clinics have Urgent Care Centers,

most with evening, weekend, and holiday

hours. Use the Provider Directory online to

find urgent care providers in other areas.

See Page 41 for a list of centers.

KAISER: Find an Urgent Care Center at www.kp.org

URGENT CARE - $10 per visitAllergiesAsthma Attack (Minor)Cold, Flu, FeverCoughDizzinessFracturesNauseaMinor BurnsMinor Cuts/LacerationsSore ThroatSprainsStitches

EMERGENCY ROOM - $200 per visit (waived if admitted)Chest PainCompound Fractures (Bone Visible)High FeverIngestion of PoisonMajor Head InjurySeizuresSevere Asthma AttackSevere BurnsShockUncontrollable Bleeding

When to Use Urgent Care vs. Emergency RoomHere are some examples of when to use urgent care or the emergency room. This is not intended as a complete list.


Manage Your Prescriptions 4Your prescriptions are a big part of your health benefits.

Make the most of them by managing them wisely.

Transfer PrescriptionsIf you have existing prescriptions, have them transferred to

Group Health Options or Kaiser Permanente to receive best benefit from your

coverage.

Mail Order PrescriptionsUsing mail order prescriptions saves money and saves time. Getting your

prescriptions by mail is free and for Group Health Options members you get a

discount of up to $5 per prescription.

URGENT CARE

How to Transfer Your PrescriptionGroup Health Options: Go online to www.ghc.org to transfer your

prescription or call Customer Service at 1-888-901-4636.

Kaiser Permanente: Go online to www.kp.org or call Customer

Service at 1-800-813-2000.

How to Set Up Mail Order PrescriptionsGroup Health Options: After setting up an online account you

can order refills online and have them mailed – free of charge –

directly to you.

Kaiser Permanente: After setting up an online account you can

order refills online and have them mailed – free of charge –

directly to you.

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HEALTH BENEFITS QUICK STARTCheck Your Eligibility for Health Benefits• You must work at least 86* hours per month for three consecutive

months to be eligible for these benefits. You do not need to wait until you are eligible to enroll, you can complete the form after you’re hired.

EnrollIndividual Providers: You can enroll by logging in to www.myseiubenefits.org and filling out the enrollment form. Agency Providers: Talk with your employer about enrollment.

Look for Your ID CardAfter you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

Fill Out Your Health Profile or Health AssessmentThe Health Profile or Assessment is an online quiz and report to help you manage your health. To help encourage participation, you will receive a check for $25 for filling it out.

Make a Primary Care AppointmentUse the online provider directory at www.ghc.org or www.kp.org to find a primary care doctor who’s a good match for you. You will receive $10 for attending a primary care appointment within the first three months of your coverage.

Locate Your Nearest Urgent Care CenterAs soon as possible, you should identify the closest urgent care center to you in case of an emergency. You can find urgent care centers online at www.ghc.org or www.kp.org.

Manage Your PrescriptionsIf you have existing prescriptions, have them transferred to Group Health Options or Kaiser Permanente. Next, set up mail order prescription refills online to save money and save time.

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

URGENT CARE

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*The work requirement in each Home Care Aide’s governing Collective Bargaining Agreement (CBA) determines their eligibility for the Trust’s benefits. Agency Providers should check the CBA for their agency to see if it has a different work requirement than 86 hours.


COVERAGE BASICS1. When I am outside Washington state or the United States am I covered by the plan?

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at: Group Health 1-888-901-4636 Kaiser 1-800-813-2000 Premera Blue Cross 1-800-722-1471 Willamette (contact the clinic where the services were provided)

2. Can I add dependents to my plan?

Individual Provider: Dependents are not covered. The Individual Provider ben-efits do not allow coverage for dependents under this plan.

Agency Provider: If you are covered by the Health Benefits Trust, you can cover dependents by paying the full premium for them through payroll deduction. De-pendents can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for information.

3. How do I cancel my coverage and the corresponding paycheck deductions?

The request must be made in writing and sent to the Health Benefits Trust via fax or U.S. Mail. Fax to 206-859-2637 or mail to SEIU Healthcare NW Health Benefits Trust PO Box 6, Mukilteo, WA 98275. Requests in writing before the 15th of the month will stop further payroll deductions.

4. If I haven’t received an ID card, who do I call?

Allow up to 10 days after your coverage begins for processing and mailing your ID cards. After you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not re-ceive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

5. Is dental or vision coverage included with this plan?

Yes. Vision coverage is part of your medical plan administered by your medi-cal health insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Premera Blue Cross or Willamette.

6. Is there a pre-existing condition waiting period?

Yes. It is a 3-month waiting period unless you have had prior documented cred-itable group coverage which can be used as a credit toward the waiting period.



ELIGIBILITY7. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month?

No. For the purpose of health care insur-ance eligibility, hours are only applicable to the month in which they are authorized, not when they are claimed or paid.

8. How do I enroll for coverage?

Individual Provider: Log on to www.mysei-ubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

Agency Provider: Contact your employer to coordinate your enrollment.

9. How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage. The work requirement in each Home Care Aide’s govern-ing Collective Bargaining Agreement (CBA) determines their eligibility for the Trust’s benefits. Agency Providers should check the CBA for their agency to see if it has a different work requirement than 86 hours.

10. I don’t have enough hours some months resulting in a lapse in coverage, do I have to meet the initial eligibility requirements again?

If you are not covered by the plan for 12 months you need to re-qualify.

11. I work for a Home Care Agency and I’m also an Individual Provider. If I’m currently enrolled in my agency employer’s plan, can I terminate that coverage and enroll in the Health Benefits Trust as an Individual Provider instead of keeping my agency plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. You’ll need to keep your current plan until your coverage as an Individual Provider begins. NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan.

FREQUENTLY ASKED QUESTIONSPO

LICIES

HOW DO I ENROLL FOR COVERAGE? Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.



12. What happens if I work less than 86 hours in a month after I am enrolled in the plan?

You will NOT have coverage the second month following the month you worked less than 86 hours.

Example: If you work only 50 hours in September, no deduction will be taken from your October paycheck and you will not have coverage for the month of November.

However, if you do not work enough hours in a month, you may choose to pay the full monthly (COBRA) premium yourself. The Health Benefits Trust will send you a COBRA notice and election form and if you sign-up for COBRA benefits, you will receive a bill for payment.

13. When can I submit my enrollment form for coverage?

Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider.


MISCELLANEOUS14. I am an Individual Provider. What if I report my hours to Social Service Payment System (SSPS) so late that they don’t make the $25 deduction from my check?

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (aka Remittance Advice) and invoice showing you claimed at least 86 hours for that month.

It is very important to report your hours to SSPS in a timely manner to avoid having to make a payment by mail. Your health insurance provider may not be able to verify your eligibility and your coverage will be considered lapsed until we receive your check and supporting documentation.

15. Can I be covered by another plan at the same time that I’m enrolled in the Health Benefits Trust Plan and use it as secondary coverage?

As in Individual Provider or Agency Provider, participants may not have other coverage. This includes Basic Health Plan, another employer’s coverage or another family member’s coverage. The only exception is that you may retain Medicare or Medicaid coverage while enrolled in the Health Benefits Trust Plan.

16. How do I notify you that my address has changed?

A request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) directly if you are an Individual Pro-vider. If you are an Agency Provider, contact your employer to make this change.


Is dental or vision coverage included with this plan?


17. I currently have coverage, but not through the Health Benefits Trust plan. Can I enroll in the Health Benefits Trust plan if my other current coverage terminates?

Yes.

18. I want to change my dental insurance provider, how can I do this?

Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date. If you are an Agency Provider, please contact your employer about open enrollment or other location change options available. If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about op-tions for changing dental insurance providers.

19. If I cancel my insurance, can I enroll again later?

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency provider, you cannot enroll again until the next annual open enrollment.

20. If I have coverage through my spouse, can I cancel that coverage and sign up for the Health Benefits Trust plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date.

21. What benefit plans are offered by the Health Benefits Trust?

Currently, three insurance providers provide fully insured medical and/or dental coverage and one insurance provider provides self-insured dental coverage. Providers currently include: Group Health Options, Kaiser Permanente, Premera Blue Cross Self-insured Dental, and Willamette Dental Group. Trust enrollees are automatically enrolled in the Group Health coverage unless they reside in the Kaiser Permanente service area (southwest Washington and Portland, OR areas). Trust enrollees have a choice of dental insurance providers.

22. What if I am currently on COBRA through another plan? Can I cancel COBRA and enroll?

Yes. There is a place on the enrollment application to indicate the current plan termination date.

FREQUENTLY ASKED QUESTIONSPO

LICIES

IS DENTAL OR VISION COVERAGE INCLUDED WITH THIS PLAN? Yes. Vision coverage is part of your medical plan administered by your medical insurance pro-vider – Group Health or Kaiser. You have the choice of dental coverage either through Pre-mera Blue Cross or Willamette.Is dental or vision

coverage included with this plan?


23. What if I have Washington’s Basic Health Plan (BHP) coverage? Can I enroll in this plan?

Only if you cancel your BHP coverage. You cannot have both. There is a place on the Health Benefit Trust’s enrollment application to indicate the termination date of the current coverage.

24. When will my coverage be effective?

Individual Providers: Log on to www.myseiubenefits.org and use the eligibility calcula-tor to estimate when your coverage will begin or call the Member Resource Center at 1-866-371-3200.

Agency Providers: please contact your Human Resources department to coordinate your enrollment.

25. Why do you need prior coverage information?

HIPAA Law allows prior group coverage to be used as a credit toward the required pre-existing condition waiting period.


WHO DO I CONTACT IF I HAVE QUESTIONS ABOUT MY BENEFITS?Contact your insurance provider directly for an explanation of benefits and/or questions you have about claims.

Group Health Options 1-888-901-4636 www.ghc.org

Kaiser Permanente 1-800-813-2000 www.kp.org

Premera Blue Cross (Dental) 1-800-722-1471 www.premera.com

Willamette Dental 1-800-359-6019 www.willamettedental.com

WHO DO I CALL TO ENROLL OR ASK ELIGIBILITY QUESTIONS?Contact the Member Resource Center toll-free at 1-866-371-3200.



26. What if I don’t want to see any doctors who practice with Group Health Medical Centers?

Each time you seek health care services, you can choose to use your in-network providers, or not. Your highest level of benefits ($0 deductible) will be found using in-network providers: Group Health Physicians for the POS (Options) plan and First Choice Health Network / Beech Street Network of Providers for the PPO (Options PPO) plan.

You will pay more out of pocket costs by using an out-of-network provider. For example, you will have a $500 deductible.

27. What does Group Health Options POS vs. PPO mean?

If you live within 30 miles of a Group Health facility or contracted provider, you will automatically be enrolled in the POS plan.

If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.

In both plans, you have the choice of in-network or out-of-network providers each time you seek service.

28. How do I look for a provider available to me through Group Health Options?

For POS Plan (within 30 miles of Group Health facilities):

On left hand column of www.ghc.org, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and choose “Options.”

For PPO Plan (all others):

On left hand column of GHC website, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and choose “Options PPO.”

Or call Group Health Customer Service toll free: 1-888-901-4636

• Findingaprovider

• Specificbenefitquestions

• Complexmedicalcarecasemanagement

• Inpatientcarecasemanagement

29. How do I look up my Group Health Medical Centers providers?

On the left hand side of the www.ghc.org website, click “Pharmacy Services.”

Group Health Options Specific Questions

POLICIES



Group Health Options PLANSGroup Health Options

Point of Service POS Plan (POS)You will be automatically enrolled in this

plan if you live within 30 miles of a Group

Health Medical Center facility or con-

tracted provider.

Group Health Options, PPO PlanYou will be automatically enrolled in this plan

if you live farther than 30 miles from a Group

Health Medical Center facility or contracted

provider.

You can choose to access coverage in- or

out-of-network each time you seek service.

You do not have to see the physicians who

practice at Group Health Medical Centers

locations, although use of these providers

will give you the most cost savings.

The First Choice Health Network has an

extensive panel of preferred providers in WA,

OR, ID, AK and MT. Beech Street providers

are located in all other states.

“Options” Options is the POS plans giving you in-

network access to Group Health Medical

Centers care, and care from contracted

providers. Out-of-network care is provided

by First Choice Health Network Providers.

“Options PPO” NetworkIn-network care is provided by First Choice

Health Network and Beech Street providers.

Out-of-network care is provided by any other

licensed provider.

Link to look up both Options and Options PPO Providers.http://myseiu.be/imSCSp

Pharmacy www.ghc.org/pharmacy/index.jhtml

POS Plan PPO Plan

In-network: Any Group Health Medi-

cal Centers or contracted community

pharmacy.;

Out-of-network: Med Impact Pharmacies

In-network: Group Health Medical Centers and

MedImpact pharmacies.

Out-of-network: All other pharmacies


FREQUENTLY ASKED QUESTIONSKaiser Permanente Specific Questions

30. What is Kaiser Permanente’s Service area?

If you live in any of the following counties/zip codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties: Clark, Cowlitz, Lewis 98591 98593 98596, Skamania 98639 98648, Wahkiakum 98612 98647

Oregon counties: Multnomah, Polk, Washington, Yamhill

31. Do I have out-of-network coverage under Kaiser Permanente?

No (with the exception of emergency services). To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility.

www.kp.org

Link to find Kaiser Permanente Providers

http://myseiu.be/mTdBBa

32. Kaiser Permanente Membership Services

Or call Kaiser Permanente Membership Services toll free: 1-800-813-2000

• Chooseaprimarycareprovider• Specificbenefitquestions• Complexmedicalcarecasemanagement• Inpatientcarecasemanagement• Speaktoanadvicenurse• AskaboutKaiserPermanentefacilitiesacrossthecountry

33. Register for Kaiser Online Access

• E-mail your doctor’s office• View select test results• Order prescription refills (and have them mailed to you, with free shipping)• Request or cancel routine appointments• Review recent past office visits• See a list of your recent immunizations and allergies• Act for a family member (e-mail your child’s doctor, and more)• Receive our monthly e-newsletterRegister at https://members.kaiserpermanente.org/redirects/register/

POLICIES


BENEFIT SUMMARIESThe following pages are benefit summaries, only, and are not intended to replace the

specifics of the individual plan’s Certificate of Coverage, Contract, or Evidence of Insur-

ance. If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of

Insurance will take precedence.

IF YOU HAVE QUESTIONSIf you have questions about your plan’s coverage,

contact your health insurance provider.

Group Health Optionswww.ghc.org1-888-901-4636Mon.-Fri., 8 a.m.-5 p.m.

Kaiser Permanente1-800-813-2000www.kp.org

Premera Blue Cross (Dental)1-800-722-1471www.premera.com

Willamette Dental1-800-359-6019www.willamettedental.com


GROUP HEALTH OPTIONS - Benefit SummariesQuestions?1-888-901-4636

www.ghc.org

NOTE: This is a benefit summary, only, and is not intended to replace the spe-

cifics of the plan’s Certificate of Coverage, Contract, or Evidence of Insurance.

If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of



Options PPO

Form No. 015-WA (4/08) Contract No. 001-WA (4/06)

BENEFIT Preferred Provider Network (PPN)

Non-Preferred Provider Network

Plan deductible No annual deductible Individual deductible: $500 per calendar year

Individual deductible carryover

Not applicable 4th quarter carryover applies

Plan coinsuranceNo plan coinsurance Plan pays 80%, you pay 20% of the

Usual, Customary and Reasonable (UCR) charges.

Out-of-pocket limit

Individual out-of-pocket limit: $1,000 Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a Preferred Provider Network (PPN) facility and ambulance services.

Individual out-of-pocket limit: $2,000 per calendar year Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:

Plan coinsurance and emergency services at a Preferred Provider Network (PPN) facility.

Pre-existing condition (PEC) waiting period

No PEC Same as preferred provider network

Lifetime maximum Unlimited Shared with preferred provider maximum

Outpatient services (Office visits)

$10 copay $10 copay, deductible and coinsurance apply

Hospital services

Inpatient services: $100 copay, per day for up to 5 days per admit

Outpatient surgery: $50 copay

Inpatient services: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Outpatient surgery: $50 copay, deductible and coinsurance apply

Prescription drugs (some injectable drugs may be covered under Outpatient services)

Formulary generic/formulary brand $15/$30 copay per 30 day supply


Prescription mail order $5 discount per 30 day supply Not covered

Acupuncture

12 visits per calendar year

$10 copay

Shared with preferred provider visit limit $10 copay, deductible and coinsurance apply

Ambulance services Plan pays 80%, you pay 20% Same as preferred provider benefit

Chemical dependency

Inpatient: $100 copay, per day for up to 5 days per admit

Outpatient: $10 copay

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply

Outpatient: $10 copay, deductible and coinsurance apply

This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage. In accordance with the Patient Protection and Affordable Care Act of 2010,

•The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan. Effective date 8/1/11.



Devices, equipment and supplies •Durable medical

equipment•Orthopedic appliances•Post-mastectomy bras

limited to two (2) every six (6) months

•Ostomy supplies•Prosthetic devices

Covered at 50% Covered at 50%

Covered at 50%, deductible applies Covered at 50%, deductible applies

Diabetic supplies

Insulin, needles, syringes and lancets-see Prescription drugs. External insulin pumps, blood glucose monitors, testing reagents and supplies-see Devices, equipment and supplies. When Devices, equipment and supplies or Prescription drugs are covered and have benefit limits, diabetic supplies are not subject to these limits.


Diagnostic lab and X-ray services

Inpatient: Covered under Hospital services Outpatient: Covered in full

Inpatient: Covered under Hospital services Outpatient: Deductible and coinsurance apply

Emergency services (copay waived if admitted)

$200 copay $200 copay

Hearing exams (routine) $10 copay $10 copay, deductible and coinsurance apply

Hearing hardware Not covered Not covered

Home health servicesCovered in full up to 130 visits total per calendar year

Shared with preferred provider visit limit Deductible and coinsurance apply

Hospice services Covered in full Deductible and coinsurance apply

Infertility services Not covered Not covered

Manipulative therapy

12 visits per calendar year $10 copay


Massage services


$10 copay


Maternity services

Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Mental Health



Options PPOBENEFIT Preferred Provider Network

(PPN)Non-Preferred Provider Network


Naturopathy


$10 copay


Newborn Services

Any applicable coinsurance applies to the newborn while both mother and baby are confined. Otherwise, all applicable inpatient cost shares apply. Office visits: See Outpatient Services; Routine well care: See Preventive care.


Obesity-related surgery (bariatric)

Not covered Not covered

Organ transplants Donor search & harvest applies to lifetime max

Unlimited, no waiting period Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

Not covered

Preventive care Well-care physicals, immunizations, Pap smear exams, mammograms

Covered in full Not covered Routine mammograms: Deductible and coinsurance apply

Rehabilitation services (Occupational, speech, physical including services for neurodevelopmentally disabled children age six and under) Rehabilitation visits are a total of combined therapy visits per calendar year

Inpatient: 60 days per calendar year $100 copay, per day for up to 5 days per admit Outpatient: 60 visits per calendar year $10 copay

Inpatient: Day limits shared with preferred provider benefit limit $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: Visit limits shared with preferred provider benefit limit $10 copay, deductible and coinsurance apply

Skilled nursing facilityCovered in full up to 60 days per calendar year

Day limits shared with preferred provider benefit, deductible and coinsurance apply

Sterilization (vasectomy, tubal ligation)*



Temporomandibular Joint (TMJ) services

$1,000 per calendar year; $5,000 lifetime max Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

Shared with preferred provider benefit Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Tobacco cessation counseling

Free & Clear Program - covered in full

Applicable cost shares apply

Routine vision care (1 visit every 12 months)


Optical hardware Lenses, including contact lenses and frames

$200 per 24 months Shared with preferred provider benefit

BENEFIT Preferred Provider Network (PPN)

Non-Preferred Provider Network

Options PPO

Coverage provided by Group Health Options RQ-45343

* Not available for Catholic Community Services Home Care Aides


OptionsBENEFIT Inside Network Outside Network

Plan deductibleNo annual deductible Individual deductible: $500 per

calendar year

Individual deductible carryover

Not applicable 4th quarter carryover applies

Plan coinsuranceNo plan coinsurance Plan pays 80%, you pay 20%

of the Usual, Customary and Reasonable (UCR) charges.

Out-of-pocket limit

Individual out-of-pocket limit: $1,000 Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Inpatient services, outpatient services, emergency services at a Managed Health Care Network (MHCN) facility and ambulance services.

Individual out-of-pocket limit: $2,000 Out-of-pocket expenses for the following covered services are included in the out-of-pocket limit: Plan coinsurance, emergency services at a non-Managed Health Care Network (MHCN) facility.

Pre-existing condition (PEC) waiting period

No PEC Same as in-network

Lifetime maximum Unlimited Shared with in-network maximum

Outpatient services (Office visits)


Hospital services

Inpatient services: $100 copay, per day for up to 5 days per admit Outpatient surgery: $50 copay

Inpatient services: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient surgery: $50 copay, deductible and coinsurance apply

Prescription drugs (some injectable drugs may be covered under Outpatient services)



Prescription mail order $5 discount per 30 day supply Not covered

Acupuncture

Self-referred up to 8 visits per medical diagnosis per calendar year; additional visits when approved by the plan $10 copay

$10 copay, deductible and coinsurance apply

Ambulance services Plan pays 80%, you pay 20% Same as in-network

Chemical dependency



This is a brief summary of benefits. THIS IS NOT A CONTRACT OR CERTIFICATE OF COVERAGE. All benefit descriptions, including alternative care, are for medically necessary services. The Member will be charged the lesser of the cost share for the covered service or the actual charge for that service. For full coverage provisions, including limitations, please refer to your certificate of coverage. In accordance with the Patient Protection and Affordable Care Act of 2010,

• The lifetime maximum on the dollar value of covered essential health benefits no longer applies. Members whose coverage ended by reason of reaching a lifetime limit under this plan are eligible to enroll in this plan. Effective date 8/1/11.


Options

Devices, equipment and supplies •Durable medical

equipment•Orthopedic appliances•Post-mastectomy bras

limited to two (2) every six (6) months

•Ostomy supplies•Prosthetic devices

Covered at 50%

Covered at 50%

Covered at 50%, deductible applies Covered at 50%, deductible applies

Diabetic supplies



Diagnostic lab and X-ray services

Inpatient: Covered under Hospital services Outpatient: MRI/PET/CT - $50 copay High end radiology imaging services such as CT, MR and PET must be determined Medically Necessary and require preauthorization except when associated with Emergency care or inpatient services.

Inpatient: Covered under Hospital services Outpatient: MRI/PET/CT - $50 copay High end radiology imaging services such as CT, MR and PET must be determined Medically Necessary and require preauthorization except when associated with Emergency care or inpatient services.

Emergency services (copay waived if admitted)

$200 copay $200 copay

Hearing exams (routine)$10 copay $10 copay, deductible and

coinsurance apply

Hearing hardware Not covered Not covered

Home health servicesCovered in full. No visit limit. No visit limit.

Deductible and coinsurance apply

Hospice services Covered in full Deductible and coinsurance apply

Infertility services Not covered Not covered

Manipulative therapySelf-referred up to 10 visits per calendar year $10 copay

Visit limits shared with in-network $10 copay, deductible and coinsurance apply

Massage services See Rehabilitation services See Rehabilitation services

Maternity services



Mental Health



BENEFIT Inside Network Outside Network


Options

Naturopathy

Self-referred up to 3 visits per medical diagnosis per calendar year; additional visits when approved by plan $10 copay

$10 copay, deductible and coinsurance apply

Newborn Services



Obesity-related surgery (bariatric)

Not covered Not covered

Organ transplants Donor search & harvest applies to lifetime max

Unlimited, no waiting period Inpatient: $100 copay, per day for up to 5 days per admit Outpatient: $10 copay

Shared with in-network Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Preventive care Well-care physicals, immunizations, Pap smear exams, mammograms

Covered in full $300 per person, coinsurance applies Routine mammograms: Deductible and coinsurance apply

Rehabilitation services (Occupational, speech, physical)) Rehabilitation visits are a total of combined therapy visits per calendar year

Inpatient: 60 days per calendar year $100 copay, per day for up to 5 days per admit Outpatient:60 visits per calendar year $10 copay

Inpatient: Day limits shared with in-network $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: Visit limits shared with in-network $10 copay, deductible and coinsurance apply

Skilled nursing facilityCovered in full up to 60 days per calendar year

Day limits shared with in-network benefit, deductible and coinsurance apply

Sterilization (vasectomy, tubal ligation)*



Temporomandibular Joint (TMJ) services

$1,000 per calendar year; $5,000 lifetime max Inpatient: $100 copay, per day for up to 5 days per admit

Outpatient: $10 copay

Shared with in-network Inpatient: $100 copay, per day for up to 5 days per admit Deductible and coinsurance apply Outpatient: $10 copay, deductible and coinsurance apply

Tobacco cessation counseling

Free & Clear Program - covered in full

Applicable cost shares apply

Routine vision care (1 visit every 12 months)


Optical hardware Lenses, including contact lenses and frames

$200 per 24 months Shared with in-network

Coverage provided by Group Health Options RQ-45343

BENEFIT Inside Network Outside Network

* Not available for Catholic Community Services Home Care Aides


NOTE: This is a benefit summary, only, and is not intended to replace the spe-

cifics of the plan’s Certificate of Coverage, Contract, or Evidence of Insurance.

If there is a contradiction, the Certificate of Coverage, Contract, or Evidence of


KAISER PERMANENTE HEALTH - Benefit SummariesQuestions?1-800-813-2000 or (503) 813-2000Member Services Weekday Hours 8am-6pmMember Services Weekend Hours Closedwww.kp.org

Individual Providers -

Medical Plan B


This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost shar-ing, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a com-plete explanation, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member

Handbook for Hawaii.

General Information

Website www.kp.org

Member Services Number 1-800-813-2000 or (503) 813-2000

Member Services Weekday Hours 8am-6pm

Member Services Weekend Hours Closed

Annual Deductible: Individual None

Annual Out-of-Pocket Max: Individual

$750 Individual

Office Visits (Outpatient)

Primary Care $10 copay

Specialty Care $10 copay / $0 preventative

Preventive Care 100% covered

Scheduled Prenatal Visits and 1st Post-partum Visit

100% covered

Well-Baby Care (23 months or younger) 100% covered

Vision Exam - Optometrist $10 copay

Vision Exam - Ophthalmologist $10 copay

Physical, Occupational, Speech Therapy $10 copay

Outpatient/Ambulatory Surgery $50 copay / $0 preventative


Medical Plan B

Continued on next page



Medical Plan BCont’d.

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, cost sharing, out-of-pocket maximums, exclusions, or limitations, nor does it list all benefits and cost sharing. For a complete explana-

tion, please refer to the applicable EOC, or to the Disclosure Form for California, or to the Member Handbook for Hawaii.

Agency Providers -

Medical Plan B

Lab and X-Ray

Laboratory 100% covered

X-Ray 100% covered

MRI/CT/PET/Nuclear Medicine $50 copay

Emergency Care

Ambulance (Ground or Air) $75 copay

Emergency Room $200 copay

Urgent Care $30 copay

Hospital Care (Inpatient)

Inpatient $100 copay

Delivery and Inpatient Baby Care $100 copay

Mental Health and Chemical Dependency

Mental Health Outpatient (Individual) $10 copay

Mental Health Outpatient (Group) $10 copay

Mental Health Inpatient $100 copay

Chemical Dependency Outpatient (Individual)

$10 copay

Chemical Dependency Outpatient (Group) $10 copay

Chemical Dependency Inpatient $100 copay

Prescription Drugs

Pharmacy/Retail: Generic $15 copay

Pharmacy/Retail: Brand $30 copay

Pharmacy/Retail: Day Supply 30

Mail Order - Generic $30 copay

Mail Order - Brand $60 copay

Mail Order - Day Supply 90

Other

Skilled Nursing Facility (SNF)100% covered; limited to

100 days per calendar year

Infertility Services Diagnosis and treatment 50% covered

Hospice Care100% covered for patient diagnosed with

life expectancy of 6 months or less

Home Health Care100% covered, limited to

130 days per year

Durable Medical Equipment (DME) 20% coinsurance

Vision Hardware $200 allowance, every 24 months

Vision Hardware$10 copay for chiro, naturopathic,

& acupuncture




General Information

Website www.kp.org

Member Services Number 1-800-813-2000 or (503) 813-2000

Member Services Weekday Hours 8am-6pm

Member Services Weekend Hours Closed

Annual Deductible: Individual/Family None

Annual Out-of-Pocket Max: Individual/Family

$750 Individual/$2250 Family

Office Visits (Outpatient)

Primary Care $10 copay

Specialty Care $10 copay / $0 preventative

Preventive Care 100% covered

Scheduled Prenatal Visits and 1st Post-partum Visit

100% covered

Well-Baby Care (23 months or younger) 100% covered

Vision Exam - Optometrist $10 copay

Vision Exam - Ophthalmologist $10 copay

Physical, Occupational, Speech Therapy $10 copay

Outpatient/Ambulatory Surgery $50 copay / $0 preventative

Agency Providers -

Medical Plan B

Continued on next page




Agency Providers - Medical Plan B

Cont’d.

Lab and X-Ray

Laboratory 100% covered

X-Ray 100% covered

MRI/CT/PET/Nuclear Medicine $50 copay

Emergency Care

Ambulance (Ground or Air) $75 copay

Emergency Room $200 copay

Urgent Care $30 copay

Hospital Care (Inpatient)

Inpatient $100 copay

Delivery and Inpatient Baby Care $100 copay

Mental Health and Chemical Dependency

Mental Health Outpatient (Individual) $10 copay

Mental Health Outpatient (Group) $10 copay

Mental Health Inpatient $100 copay

Chemical Dependency Outpatient (Individual)

$10 copay

Chemical Dependency Outpatient (Group) $10 copay

Chemical Dependency Inpatient $100 copay

Prescription Drugs

Pharmacy/Retail: Generic $15 copay

Pharmacy/Retail: Brand $30 copay

Pharmacy/Retail: Day Supply 30

Mail Order - Generic $30 copay

Mail Order - Brand $60 copay

Mail Order - Day Supply 90

Other

Skilled Nursing Facility (SNF)100% covered; limited to

100 days per calendar year

Infertility Services Diagnosis and treatment 50% covered

Hospice Care100% covered for patient diagnosed with

life expectancy of 6 months or less

Home Health Care100% covered, limited to

130 days per year

Durable Medical Equipment (DME) 20% coinsurance

Vision Hardware $200 allowance, every 24 months

Vision Hardware$10 copay for chiro, naturopathic,

& acupuncture




PREMERA DENTAL - Benefit Summaries

NOTE: This is a benefit summary only and is not intended to replace the spe-

cifics of the Self-funded Dental Plan Document. If there is a contradiction, the

Plan Document will govern.


PREMERA DENTAL - Benefit Summaries

An Independent Licensee of the Blue Cross Blue Shield Association Continued on next page

Group Number: 1034825

Effective date: 8/1/2011

DENTAL PLAN DENTAL PREFERENCES FLEX PLUS— STANDARD PPO –

INDIVIDUAL PROVIDER

COVERED SERVICES IN-NETWORK OUT-OF-NETWORK

Individual/Family Deductible PCY $0 $50 (waived for diagnostic/preventive)

DIAGNOSTIC/PREVENTIVE $0 20%

- cleanings (limited to 2 PCY)- fluoride treatments (limited to 2 applications

PCY for members age 19 and under)- routine oral exams (limited to 2 PCY)- routine x-rays (complete series or panoramic

x-ray once every 5 calendar years, but not both)

- sealants (limited to permanent teeth for members age 18 and under)

- space maintainers

BASIC $0 40%

- emergency exams (unlimited)- non-routine exams (limited to 1 PCY)

- emergency palliative treatment

- endodontic (root canal) treatment (limited to once per tooth every 2 calendar years)

- fillings

- full mouth debridement (limited to once every 3 calendar years)

- periodontal maintenance (limited to 2 visits per calendar year)

- periodontal scaling (limited to once per quadrant every 2 calendar years)

- periodontal surgery once in the same quadrant every 3 calendar years

Standard PPO


BASIC Continued $0 40%

- limited occlusal adjustments (limited to 1 PCY)

- re-cementing of crowns, inlays, bridgework and dentures

- re-line, re-base, and adjustments when performed six or more months after denture installation

- simple and surgical extractions- general anesthesia (limited to covered dental

procedures at a dental care providers office when dentally necessary)

MAJOR 20% 60%

- repair of crowns, inlays, bridgework and dentures

- inlays, onlays and crowns (replacements limited to once per tooth every 7 calendar years)

- dentures, partials and fixed bridges (replacements limited to once every 7 calendar years)

- implant and implant related services once every 7-consecutive years

- Stainless steel crowns on non-permanent molars are limited to once per tooth every 5 calendar years

Annual Maximum $1,000 PCY Shared with In-Network Cost Share

Any deductibles, copays, and coinsurance percentages shown are amounts for which you’re responsible.

In-network services aren’t subject to a calendar year deductible. The out-of-network calendar year deductible is waived for Diagnostic/Preventive Care services.

PCY = Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross. Members are responsible for amounts in excess of the allowable charge.

This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. This benefit highlight is not a contract. For full coverage provisions, including a description of waiting periods, limitations and exclusions please contact Customer Service.


An Independent Licensee of the Blue Cross Blue Shield Association Continued on next page

Group Number: 1034826

Any deductibles, copays, and coinsurance percentages shown are amounts for which you’re responsible.

Effective date: 8/1/2011DENTAL PLAN DENTAL PREFERENCES FLEX PLUS—

OUT OF AREA PLAN

COVERED SERVICES IN-NETWORK OUT-OF-NETWORK

Individual/Family Deductible PCY $0 $50 (waived for diagnostic/preventive)

DIAGNOSTIC/PREVENTIVE $0 $0

- cleanings (limited to 2 PCY)- fluoride treatments (limited to 2 applications

PCY for members age 19 and under)- routine oral exams (limited to 2 PCY)- routine x-rays (complete series or panoramic

x-ray once every 5 calendar years, but not both)

- sealants (limited to permanent teeth for members age 18 and under)

- space maintainers

BASIC $0 20%

- emergency exams (unlimited)- non-routine exams (limited to 1 PCY)

- emergency palliative treatment

- endodontic (root canal) treatment (limited to once per tooth every 2 calendar years)

- fillings

- full mouth debridement (limited to once every 3 calendar years)

- periodontal maintenance (limited to 2 visits per calendar year)

- periodontal scaling (limited to once per quadrant every 2 calendar years)

- periodontal surgery once in the same quadrant every 3 calendar years

Out-of-Area Plan


An Independent Licensee of the Blue Cross Blue Shield Association

BASIC Continued $0 20%

- limited occlusal adjustments (limited to 1 PCY)

- re-cementing of crowns, inlays, bridgework and dentures

- re-line, re-base, and adjustments when performed six or more months after denture installation

- simple and surgical extractions- general anesthesia (limited to covered dental

procedures at a dental care providers office when dentally necessary)

MAJOR 20% 50%

- repair of crowns, inlays, bridgework and dentures

- inlays, onlays and crowns (replacements limited to once per tooth every 7 calendar years)

- dentures, partials and fixed bridges (replacements limited to once every 7 calendar years)

- implant and implant related services once every 7-consecutive years

- Stainless steel crowns on non-permanent molars are limited to once per tooth every 2 calendar years

- Stainless steel crowns on permanent molars are limited to once per tooth every 5 calendar years

Annual Maximum $1,000 PCY Shared with In-Network Cost Share

In-network services aren’t subject to a calendar year deductible. The out-of-network calendar year deductible is waived for Diagnostic/Preventive Care services.

PCY = Per calendar year. Balance billing may apply if a provider is not contracted with Premera Blue Cross. Members are responsible for amounts in excess of the allowable charge.

This is not a complete explanation of covered services, exclusions, limitations, reductions or the terms under which the program may be continued in force. This benefit highlight is not a contract. For full coverage provisions, including a description of waiting periods, limitations and exclusions please contact Customer Service.


WILLAMETTE DENTAL - Benefit SummariesQuestions?1-800-359-6019

www.willamettedental.com

IP Plan &Agency Plan

NOTE: This is a benefit summary only and is not intended to replace the

specifics of the Self-funded Dental Plan Document. If there is a contradiction,

the Plan Document will govern.


BENEFIT CO-PAYMENT

Annual Maximum No Annual Maximum*

Deductible No Deductible

General Office Visit $15 per Visit

DIAGNOSTIC AND PREVENTIVE SERVICES

Routine and Emergency Exams Covered at 100%

All X-rays Covered at 100%

Teeth Cleaning Covered at 100%

Fluoride Treatment Covered at 100%

Sealants Covered at 100%

Head and Neck Cancer Screening Covered at 100%

Oral Hygiene Instruction Covered at 100%

Periodontal Charting Covered at 100%

Periodontal Evaluation Covered at 100%

RESTORATIVE DENTISTRY

Fillings (Amalgam) Covered at 100%

Stainless Steel Crown Covered at 100%

Porcelain-Metal Crown $250

PROSTHETICS

Complete Upper or Lower Denture $400

Bridge (per Tooth) $250

ENDODONTICS AND PERIODONTICS

Root Canal Therapy – Anterior $85

Root Canal Therapy – Bicuspid $105

Root Canal Therapy – Molar $130

Osseous Surgery (per Quadrant) $150

Root Planing (per Quadrant) $75

ORAL SURGERY

Routine Extraction (Single Tooth) Covered at 100%

Surgical Extraction $100

ORTHODONTIA

Pre-Orthodontic Service $150**

Comprehensive Orthodontia Value Added Services Available

MISCELLANEOUS

Local Anesthesia (Novocain) Covered at 100%

Dental Lab Fees Covered at 100%

Nitrous Oxide $40 per Visit

Specialty Office Visit $30 per Visit

Emergency Office Visit $50 per Visit

Out of Area Emergency Care Reimbursement up to $250*TMJ has a $1000 annual maximum / $5000 lifetime maximum

IP Plan &Agency Plan

**Fee credited towards

comprehensive orthodontic

co-payment if patient accepts treatment plan.



When you have questions or a complaint about health or dental coverage:Call the Customer Service Department of your insurer, or,

for the Trust’s self-funded dental plan, Premera Blue Cross:

Group Health Options

1-800-542-6312

www.ghc.org

Kaiser Permanente

1-800-813-2000

www.kp.org

Willamette Dental

Oregon: 1-800-461-8994

Washington: 1-800-359-6019

www.willamettedental.com

Self-funded Dental Plan

Claims Administered by

Premera Blue Cross

1-800-547-9515

www.premera.com

What if I Have a Health Insurance or Dental Coverage Question or an Appeal?

QUESTIONS & APPEALS


When you have an appeal:An appeal is a request to reconsider a decision to deny, modify, reduce, or

end payment, coverage or authorization of coverage (known as an “adverse

decision”).

The appeal process for each of the Trust’s health and dental plans is different.

You should review the Summary Plan Description of appeals procedures in

your Benefits Summary provided by your insurer or, in the case of the Trust’s

self-funded dental coverage, by Premera Blue Cross. The Summary Plan

Description contains a full explanation of the appeals process.

You may also call the Customer Service Department of your insurer or, in

the case of the Trust’s self-funded dental coverage, Premera Blue Cross, for

specific information about the appeals process. Those numbers are listed on

the previous page.

Your rights in an appeal:

• You must submit your appeals within 180 calendar days of the date you

received notice of an “adverse decision.” Keep track of these deadlines

as appeals that are filed late may not be considered.

• You may request an expedited 72-hour review of your appeal when the

adverse determination could jeopardize your life or health.

• You may request all of the documents relevant to your request and the

decision by the insurer or administrator.

• You may submit additional comments, documents or other information to

support your appeal.

More information about how to file an appeal can be found at “How to Appeal

a Health Care Insurance Decision, A Guide for Consumers in Washington

State” on the Office of the Insurance Commissioner’s website,

www.insurance.wa.gov/consumers/health/Appeal/Table-of-Contents.shtml

QUESTIONS & APPEALS


GLOSSARYAAA – Area Agency on Aging

ABT – Accelerated Basic Training

ADSA – Aging and Disability Services Administration Department of Department of Social and Health Services serving adults with chronic illnesses or conditions and people with developmental disabilities.

AP – Agency Provider A Home Care Aide who works for an agency – agency provider

ARC – Advocates for the Rights of Citizens with Developmental Disabilities

BHP – Basic Health Plan of Washington

CNA – Certified Nursing Assistant

CE – Continuing Education Supplemental training required for skills development

COBRA – A private-pay insurance that covers you if you have a lapse in cover-age or you are between jobs

cultural competency – An awareness of the customs, beliefs and religious practices of others

DDD – Division of Developmental Disabilities

diagnostic imaging – MRI (Magnetic Resonance Imaging), X-rays, mammograms

DME – Durable Medical Equipment Walkers, crutches, etc.

DSHS – Department of Social and Health Services

HCS – Home Community Services The Home Community Services (HCS) Division of DSHS promotes, plans, develops and provides long-term care services for persons with disabilities and older adults who may need state funds (Medicaid) to help pay for them.

health insurance provider – The company that manages your health insurance, for example Group Health, Kaiser Permanente.

Health Risk Assessment or Health Profile – An online health assessment or questionnaire that assesses your general health and wellness through a series of questions


GLOSSARYIP – Individual Provider A Home Care Aide that provides care to a consumer living in his or her home and whose employer of record is the Department of Social and Health Services.

LPN – Licensed Practical Nurse

MFOC – Modified Fundamentals of Caregiving

MRC – Member Resource Center

NDC – Nurse Delegated Core

NDD – Nurse Delegation Diabetes

orthopedic appliances – braces, splints, etc.

PCP – Primary Care Provider The doctor you choose to oversee your care

POS – Point of Service Insurance pays percentage of doctor visit that is out-of-network

PPO – Preferred Provider Organization A provider who is in-network

RN – Registered Nurse

RNA – Registered Nurse’s Assistant

S&O – Safety and Orientation

TBI – Traumatic Brain Injury

Training Wizard – A computer program that assists you in getting started at the Training Partnership www.myseiubenefits.org/wizard


About This Guide

This handbook is intended to be an overview of your benefits and a general

resource. For more detailed information about your health and dental ben-

efits, you should consult the Summary Plan Description (SPD) and Certificate

of Coverage for those benefits. This handbook is not a “Plan document” or

the official SPD. In case of any conflict between this document and any “Plan

document,” the terms of the Plan Document shall govern.

The handbook is not a promise of benefits. All benefits described in the hand-

book are provided pursuant to existing collective bargaining agreements (CBA)

and employer participation agreements with the SEIU Healthcare NW Health

Benefits Trust and Training Partnership. Should the CBA or other agreements

with the Health Benefits Trust and/or Training Partnership terminate, change

or otherwise become ineffective, the benefits described in this book may also

terminate or change.

Equal Opportunity

The SEIU Healthcare NW Training Partnership (“Partnership”) admits students

regardless of race, color, national origin, ethnic origin, gender, age, disability

and sexual orientation to all the rights, privileges, programs, and activities gen-

erally accorded or made available to students by the Training Partnership. It

does not discriminate on the basis of race, color, national origin, ethnic origin,

gender, age, disability and sexual orientation in administration of its training

and educational policies, admissions policies, scholarship and loan programs,

and other Training Partnership administered programs.

NOTICES


2011-2012 GUIDE TO TRAINING AND HEALTH BENEFITSInside:• Changes to Training Standards and Benefits• Ways to stay healthy, save money and save time• How to access training and health benefits online

… and much more!

635 Andover Park W. Suite 200, Tukwila, WA 98188

WWW.MYSEIUBENEFITS.ORG

PRSRT STD US POSTAGE

PAIDPERMIT NO. 5544

SEATTLE WA

TP-HBT-BB-101

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